Covered Entity Details

FQHCLA211 HEALTH CENTERS DETROIT MEDICAL GROUP (Active) - information as of 5/5/2025 10:06:07 PM

Main Details

Name

HEALTH CENTERS DETROIT MEDICAL GROUP

Subdivision Name

ADMINISTRATIVE

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-009712

340B ID

FQHCLA211

Grant Number

LALCS00008

Additional Details

Current Program Status

Active

Registration Date

11/29/2006

Participating Start Date

1/1/2007

Participating Approval Date

12/4/2006

Last Recertification Date

3/5/2025

Contacts

Authorizing Official

HCDF, Inc.
HERBERT C. SMITHERMAN, PRESIDENT AND CEO
(313) 966-5187

Primary Contact

Health Centers Detroit Foundation, Inc.
Andrew S Dignan, CAO, CIO
(313) 966-5187

Addresses

Street Address

4201 ST ANTOINE BLVD, 9D
DETROIT, MI 48201-2153

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
9/25/2008-UPDATED ADD. (WAS UHC-7A)	11/29/2006

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	WAL-MART PHARMACY 10-5184	6674 WINCHESTER BLVD		CANAL WINCHESTER	OH	43110	01/03/2024	04/01/2024	04/11/2024	04/11/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04797	6331 E JEFFERSON AVE	DETROIT	MI	48207-4317	04/16/2013	07/01/2013		04/16/2013
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05226	14048 WOODWARD AVE	HIGHLAND PARK	MI	48203	04/16/2013	07/01/2013	03/21/2017	03/15/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #21244	1843 E 8 MILE RD	HAZEL PARK	MI	48030	04/16/2013	07/01/2013		04/16/2013
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07208	23111 LAHSER ROAD	SOUTHFIELD	MI	48033	04/16/2013	07/01/2013		04/16/2013
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05425	13550 W 9 MILE ROAD	OAK PARK	MI	48237	04/16/2013	07/01/2013	04/02/2024	04/11/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06708	15516 GRAND RIVER AVE	DETROIT	MI	48227-2223	04/16/2013	07/01/2013	08/11/2015	08/12/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04367	8706 N. TELEGRAPH ROAD	DEARBORN HEIGHTS	MI	48127	04/16/2013	07/01/2013		04/16/2013
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04501	22380 MOROSS ROAD	DETROIT	MI	48236	04/16/2013	07/01/2013		04/16/2013
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05969	29030 NORTHWESTERN HWY	SOUTHFIELD	MI	48034	04/16/2013	07/01/2013		04/16/2013
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06360	20001 W 7 MILE	DETROIT	MI	48219	04/16/2013	07/01/2013	02/05/2020	02/05/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04369	19800 PLYMOUTH RD.	DETROIT	MI	48228	04/16/2013	07/01/2013	08/11/2015	08/12/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04748	30852 WOODWARD AVE	ROYAL OAK	MI	48073	04/16/2013	07/01/2013		04/16/2013
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04749	1765 FORT ST.	LINCOLN PARK	MI	48146	04/16/2013	07/01/2013		04/16/2013
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05084	24133 GRAND RIVER AVE	DETROIT	MI	48219	04/16/2013	07/01/2013	08/11/2015	08/12/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05083	17755 E 8 MILE RD	EASTPOINTE	MI	48021	04/16/2013	07/01/2013	06/21/2017	07/05/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05032	13601 W. WARREN AVE.	DEARBORN	MI	48126	04/16/2013	07/01/2013		04/16/2013
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04864	7380 ORCHARD LAKE RD.	WEST BLOOMFIELD	MI	48322	04/16/2013	07/01/2013		04/16/2013
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06313	27750 GRAND RIVER AVE	FARMINGTON HILLS	MI	48336	04/16/2013	07/01/2013		04/16/2013
Contract Detail	WALGREEN CO.	DBA: WALGREENS #21364	15840 W 12 MILE RD	SOUTHFIELD	MI	48076	04/16/2013	07/01/2013		04/16/2013
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04601	690 MARTIN LUTHER KING JR BLVD N	PONTIAC	MI	48342	04/16/2013	07/01/2013	03/21/2017	03/18/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06546	9100 TELEGRAPH RD	TAYLOR	MI	48180	04/16/2013	07/01/2013		04/16/2013
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 01610	21211 HARPER AVE	ST CLAIR SHORES	MI	48080-2208	04/16/2013	07/01/2013		04/16/2013
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04512	22950 VAN DYKE AVE.	WARREN	MI	48089	04/16/2013	07/01/2013		04/16/2013
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04608	1045 S. GRATIOT AVE.	CLINTON TOWNSHIP	MI	48036	04/16/2013	07/01/2013		04/16/2013
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16374	4501 WOODWARD AVE STE 105	DETROIT	MI	48201	01/17/2017	04/01/2017		01/17/2017
Contract Detail	WALGREEN CO.	WALGREENS #21206	6001 W OUTER DR STE 110	DETROIT	MI	48235-2626	01/15/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #21207	3901 BEAUBIEN ST RM 108	DETROIT	MI	48201-2119	01/15/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #21208	4201 SAINT ANTOINE ST STE 2M	DETROIT	MI	48201-2153	01/15/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	DBA WALGREENS #21209	3990 JOHN R ST., STE 1460	DETROIT	MI	48201-2018	01/15/2019	04/01/2019		04/01/2019
Contract Detail	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	04/11/2024	07/01/2024		07/01/2024
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/16/2013	07/01/2013	07/10/2015	07/15/2015
Contract Detail	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	04/16/2013	07/01/2013	07/10/2015	07/15/2015

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
FQHCLA211	Active	BPS-LAL-009712	HEALTH CENTERS DETROIT MEDICAL GROUP	ADMINISTRATIVE	4201 ST ANTOINE BLVD, 9D	DETROIT	MI
FQHCLA211A	Active	BPS-LAL-017140	HEALTH CENTERS DETROIT MEDICAL GROUP		23077 GREENFIELD ROAD, SUITE 400	SOUTHFIELD	MI
FQHCLA211B	Active	BPS-LAL-009710	HEALTH CENTERS DETROIT MEDICAL GROUP		7633 EAST JEFFERSON AVENUE, Ste. 340	DETROIT	MI
FQHCLA211C	Active	BPS-LAL-009712	HEALTH CENTERS DETROIT MEDICAL GROUP		4201 ST. ANTOINE BLVD., UHC 7A	DETROIT	MI

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
FQHCLA211	WAL-MART PHARMACY 10-5184	6674 WINCHESTER BLVD		CANAL WINCHESTER	OH	43110	04/01/2024	04/11/2024
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 04797	6331 E JEFFERSON AVE	DETROIT	MI	48207-4317	07/01/2013
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 05226	14048 WOODWARD AVE	HIGHLAND PARK	MI	48203	07/01/2013	03/21/2017
FQHCLA211	WALGREEN CO.	DBA: WALGREENS #21244	1843 E 8 MILE RD	HAZEL PARK	MI	48030	07/01/2013
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 07208	23111 LAHSER ROAD	SOUTHFIELD	MI	48033	07/01/2013
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 05425	13550 W 9 MILE ROAD	OAK PARK	MI	48237	07/01/2013	04/02/2024
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 06708	15516 GRAND RIVER AVE	DETROIT	MI	48227-2223	07/01/2013	08/11/2015
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 04367	8706 N. TELEGRAPH ROAD	DEARBORN HEIGHTS	MI	48127	07/01/2013
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 04501	22380 MOROSS ROAD	DETROIT	MI	48236	07/01/2013
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 05969	29030 NORTHWESTERN HWY	SOUTHFIELD	MI	48034	07/01/2013
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 06360	20001 W 7 MILE	DETROIT	MI	48219	07/01/2013	02/05/2020
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 04369	19800 PLYMOUTH RD.	DETROIT	MI	48228	07/01/2013	08/11/2015
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 04748	30852 WOODWARD AVE	ROYAL OAK	MI	48073	07/01/2013
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 04749	1765 FORT ST.	LINCOLN PARK	MI	48146	07/01/2013
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 05084	24133 GRAND RIVER AVE	DETROIT	MI	48219	07/01/2013	08/11/2015
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 05083	17755 E 8 MILE RD	EASTPOINTE	MI	48021	07/01/2013	06/21/2017
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 05032	13601 W. WARREN AVE.	DEARBORN	MI	48126	07/01/2013
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 04864	7380 ORCHARD LAKE RD.	WEST BLOOMFIELD	MI	48322	07/01/2013
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 06313	27750 GRAND RIVER AVE	FARMINGTON HILLS	MI	48336	07/01/2013
FQHCLA211	WALGREEN CO.	DBA: WALGREENS #21364	15840 W 12 MILE RD	SOUTHFIELD	MI	48076	07/01/2013
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 04601	690 MARTIN LUTHER KING JR BLVD N	PONTIAC	MI	48342	07/01/2013	03/21/2017
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 06546	9100 TELEGRAPH RD	TAYLOR	MI	48180	07/01/2013
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 01610	21211 HARPER AVE	ST CLAIR SHORES	MI	48080-2208	07/01/2013
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 04512	22950 VAN DYKE AVE.	WARREN	MI	48089	07/01/2013
FQHCLA211	WALGREEN CO.	DBA: WALGREENS # 04608	1045 S. GRATIOT AVE.	CLINTON TOWNSHIP	MI	48036	07/01/2013
FQHCLA211	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16374	4501 WOODWARD AVE STE 105	DETROIT	MI	48201	04/01/2017
FQHCLA211C	WALGREEN CO.	WALGREENS #21208	4201 SAINT ANTOINE ST STE 2M	DETROIT	MI	48201-2153	04/01/2019
FQHCLA211C	WALGREEN CO.	DBA WALGREENS #21209	3990 JOHN R ST., STE 1460	DETROIT	MI	48201-2018	04/01/2019
FQHCLA211C	WALGREEN CO.	WALGREENS #21207	3901 BEAUBIEN ST RM 108	DETROIT	MI	48201-2119	04/01/2019
FQHCLA211C	WALGREEN CO.	WALGREENS #21206	6001 W OUTER DR STE 110	DETROIT	MI	48235-2626	04/01/2019
FQHCLA211	WALGREEN CO.	WALGREENS #21206	6001 W OUTER DR STE 110	DETROIT	MI	48235-2626	04/01/2019
FQHCLA211	WALGREEN CO.	WALGREENS #21207	3901 BEAUBIEN ST RM 108	DETROIT	MI	48201-2119	04/01/2019
FQHCLA211	WALGREEN CO.	WALGREENS #21208	4201 SAINT ANTOINE ST STE 2M	DETROIT	MI	48201-2153	04/01/2019
FQHCLA211	WALGREEN CO.	DBA WALGREENS #21209	3990 JOHN R ST., STE 1460	DETROIT	MI	48201-2018	04/01/2019
FQHCLA211	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	07/01/2024
FQHCLA211	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013	07/10/2015
FQHCLA211	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	07/01/2013	07/10/2015

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/22/2024 12:22:54 PM	3/5/2025 10:03:51 AM	3/5/2025 10:03 AM
Details	Last Recertification Date	Update	Recertification	2/22/2023 11:23:27 AM	2/22/2024 12:22:54 PM	2/22/2024 12:22 PM
Details	Last Recertification Date	Update	Recertification	2/28/2022 5:01:04 PM	2/22/2023 11:23:27 AM	2/22/2023 11:23 AM
Details	Last Recertification Date	Update	Recertification	2/24/2021 12:58:03 PM	2/28/2022 5:01:04 PM	2/28/2022 5:01 PM
Details	Last Recertification Date	Update	Recertification	2/5/2020 2:23:58 PM	2/24/2021 12:58:03 PM	2/24/2021 12:58 PM
Details	Last Recertification Date	Update	Recertification	2/4/2019 6:04:00 PM	2/5/2020 2:23:58 PM	2/5/2020 2:23 PM
Contacts	Primary Contact	Update	Profile Change Request	Dignan, Andrew S CIO Health Centers Detroit Foundation, Inc. 3139665187	Dignan, Andrew S CAO, CIO Health Centers Detroit Foundation, Inc. 3139665187	11/19/2019 8:56 PM
Contacts	Primary Contact	Update	Change Request	ECTOR, AUDREY EXECUTIVE ASSISTANT HCDF, Inc. 3139665187	Dignan, Andrew S CIO Health Centers Detroit Foundation, Inc. 3139665187	3/7/2019 5:05 PM
Details	Last Recertification Date	Update	Recertification	3/5/2018 6:53:12 PM	2/4/2019 6:04:00 PM	2/4/2019 6:04 PM
Details	Last Recertification Date	Update	Recertification	2/16/2017 12:00:00 AM	3/5/2018 6:53:12 PM	3/5/2018 6:53 PM
Details	Grant Number	Update	Recertification	LAL000008	LALCS00008	3/5/2018 6:53 PM
Contacts	Primary Contact	Update	Recertification	ECTOR, AUDREY EXECUTIVE ASSISTANT 3139665187	ECTOR, AUDREY EXECUTIVE ASSISTANT HCDF, Inc. 3139665187	3/5/2018 6:50 PM
Contacts	Authorizing Official	Update		SMITHERMAN, HERBERT C. PRESIDENT AND CEO 3139665187	SMITHERMAN, HERBERT C. PRESIDENT AND CEO HCDF, Inc. 3139665187	3/5/2018 6:43 PM
Contacts	Authorizing Official	Update		SMITHERMAN, HERBERT C. PRESIDENT AND CEO 3139665187	SMITHERMAN, HERBERT C. PRESIDENT AND CEO 3139665187	7/5/2017 11:47 PM
Addresses	Main Address	Insert			4201 ST ANTOINE BLVD, 9D DETROIT, MI 48201-2153	2/16/2017 12:42 PM
Contacts	Primary Contact	Update		ECTOR, AUDREY EXECUTIVE ASSISTANT 3139665187	ECTOR, AUDREY EXECUTIVE ASSISTANT 3139665187	2/16/2017 12:42 PM
Details	Last Recertification Date	Update		2/23/2016 12:00:00 AM	2/16/2017 12:00:00 AM	2/16/2017 12:42 PM
Details	Last Recertification Date	Update		2/9/2015 12:00:00 AM	2/23/2016 12:00:00 AM	2/23/2016 10:52 AM
Contacts	Primary Contact	Insert			ECTOR, AUDREY EXECUTIVE ASSISTANT 3139665187	2/9/2015 9:29 AM
Details	Last Recertification Date	Update		2/12/2014 12:00:00 AM	2/9/2015 12:00:00 AM	2/9/2015 9:29 AM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	2/12/2014 12:00:00 AM	2/12/2014 11:56 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/25/2013 2:07 PM
Details	Grant Number	Update			LAL000008	2/25/2013 2:07 PM
Contacts	Authorizing Official	Insert			SMITHERMAN, HERBERT C. PRESIDENT AND CEO 3139665187	9/25/2008 2:40 PM
Details	Grant Number	Update		LAL000003		9/25/2008 2:06 PM
Details	Last Recertification Date	Insert				11/29/2006 1:28 PM
Details	Grant Number	Insert			LAL000003	11/29/2006 1:28 PM
Details	340B ID	Insert			FQHCLA211	11/29/2006 1:28 PM
Details	Is Authorizing Official EHB Data	Insert				11/29/2006 1:28 PM
Dates	Last Date That 340B Drugs Purchased	Insert				11/29/2006 1:28 PM
Details	Medicare Provider Number	Insert				11/29/2006 1:28 PM
Details	Entity Name	Insert			HEALTH CENTERS DETROIT MEDICAL GROUP	11/29/2006 1:28 PM
Details	Program Code	Insert			FQHCLA	11/29/2006 1:28 PM
Details	Entity Subname	Insert			ADMINISTRATIVE	11/29/2006 1:28 PM
Dates	Participating Approval Date	Insert			12/4/2006 12:00:00 AM	11/29/2006 1:28 PM
Details	State	Insert			Active	11/29/2006 1:28 PM
Dates	Registration Date	Insert			11/29/2006 12:00:00 AM	11/29/2006 1:28 PM
Dates	Signed By Date	Insert			11/8/2006 12:00:00 AM	11/29/2006 1:28 PM
Dates	Start Date	Insert			1/1/2007 12:00:00 AM	11/29/2006 1:28 PM
Terminations	Termination Comments	Insert				11/29/2006 1:28 PM
Terminations	Termination Date	Insert				11/29/2006 1:28 PM
Terminations	Termination Effective Date	Insert				11/29/2006 1:28 PM
Terminations	Termination Reason	Insert				11/29/2006 1:28 PM
Details	Comments Public	Insert			9/25/2008-UPDATED ADD. (WAS UHC-7A)	11/29/2006 1:28 PM

340B Drug Pricing Program Database